Anxiety

Anxiety

Verified by World Mental Healthcare Association

Anxiety is our natural reaction to stress and is typically considered a healthy response as it makes us alert. But if you experience high levels of anxiety regularly, then it can be a sign of an anxiety disorder.

What Is Anxiety?

Anxiety is a mental state that causes distress, increased arousal, expectancy, worries, tension, fear, nervousness, inner mental turmoil & specific behavior patterns 1. It is a physical, psychological, and behavioral reaction to an actual or potential threat to survival.

What does anxiety feel like?

Anxiety can have certain physical manifestations 2, such as rapid heartbeat, dizziness, fatigue, etc. It can also lead to intrusive and repetitive thoughts or worries, abnormal behavior and avoidance of situations that trigger fear or worry.

If you experience disproportionate levels of anxiety for over 6 months which impair your ability to perform daily tasks, then you may be suffering from a type of anxiety disorder.

Case Example

Consider the case of 17-year-old Rohit.

Rohit had always been top of his class for as long as he could remember. Over the years, academic achievement and validation became quite important to him.

His teachers and parents always expected the best out of him, which was something that motivated him, but at the same time often stressed him out. It reached a point where he would get extremely distressed every time he failed to score the highest in a test.

A few weeks before his board exams, Rohit started feeling constantly worried about his performance. He was afraid that he might disappoint everyone who believed in him as he was not adequately prepared and might not score according to expectations.

He started getting irritated with his friends and siblings, frequently snapping at them over minor issues. His mother complained that he would often go days without eating or sleeping.

He was subsequently losing a lot of weight and experiencing migraine along with fainting spells. As a result, he was unable to concentrate in his studies, and this further increased his stress.

Rohit’s concerned mother finally took him to a psychologist, who then diagnosed him with an anxiety disorder. After educating Rohit about his condition, she proceeded to teach him techniques to help him deal with his condition and recommended him to visit a psychiatrist for medical treatment.

Psychology Of Anxiety

Anxiety, which leads to hyperarousal and increased sensitivity, kept our ancestors safe by alerting them about incoming predators and other dangers in the environment.

By putting the body in high alert mode and triggering the fight-or-flight response 3, it allowed us to take necessary action and ensure our survival, either by confronting or running away from possible threats.

Although we may not need to protect ourselves from predators nowadays, feelings of anxiousness still function to protect us from any potential dangers.

Hence, important life issues, like career, finances, education, health, family, and others can make us feel anxious even though these may not necessitate the activation of the fight-or-flight response. In certain other situations, the feelings of nervousness can help us avoid danger such as when crossing the street or walking alone at night.

Normal Anxiety vs. Anxiety Disorders

We may often feel anxious before certain challenging tasks, such as taking a test, meeting a deadline at work, or giving a presentation. This feeling can help us stay focused and enable us to overcome challenges or make important decision.

However, if you are suffering from an anxiety disorder, the level of anxiety you feel is likely to be disproportionate to the amount of threat. Thus, instead of motivating you to function better, symptoms of anxiety disorders can often impair your ability to carry out day to activities.

Anxiety Disorders

Anxiety disorders refer to a set of psychiatric conditions marked by intrusive recurring thoughts or worries, panic, and constant fear which gets worse over time. According to a research paper 4, around 2%-4% of the general population tend to experience symptoms that can be classified as an anxiety disorder.

These are different from normal anxiety as these last persistently for over 6 months. Moreover, the intensity of the threat is what distinguishes anxiety disorders from normal anxiety—in anxiety disorders, the reaction is always disproportionate to the threat.

Anxiety disorders include conditions 5 such as generalized anxiety disorder, specific phobias, social anxiety disorder, panic disorder, and others. These disorders can adversely affect and impair your ability to perform daily activities—making you avoid anxiety-inducing situations at school, work, and other places. Such circumstances can trigger your symptoms, making you engage in what is collectively known as ‘safety behaviors’.

Such feelings can lead to age-inappropriate or disproportionate reactions that are not in line with the actual stressor. This can then go on to affect your education, career, and relationships.

According to a 2017 study 6, anxiety disorders are among the most prevalent psychiatric disorders, and are related to a high burden of illness. However, they are usually underrecognized, underdiagnosed, and undertreated.

Research 7 shows that global prevalence of anxiety is around 7.3%, with specific phobias being the most common. Moreover, women 8 are 2 times more likely than men to develop these disorders. These conditions also have a high comorbidity with depressive disorders.

Read More About Depressive Disorder Here

Types Of Anxiety Disorder

According to research 2, anxiety disorders include the following types of mental illnesses based on the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) –

Types of anxiety disorder
Anxiety

1. Generalized Anxiety Disorder (GAD)

GAD 9 is characterized by extreme, unrealistic and constant worry about different aspects of daily life, such as school, work, finance, health, relationships, future etc. It causes excessive worry, fear, restlessness, irritability and fatigue making the person feel persistently overwhelmed.

[Read more]

2. Separation Anxiety Disorder (SAD)

SAD is regarded as one of the most common 10 childhood anxiety disorders. It involves extreme worry and dread of a perceived or actual separation from an attachment figure. It is generally an abnormal and exaggerated level of concern for their age & development level. It can also be observed in adults and can impair daily functioning & quality of life.

[Read more]

3. Social Anxiety Disorder

Social anxiety, also known as social phobia 11,is a persistent and intense fear of social situations, especially when interaction or performance is involved. The person may be afraid that they will be criticized, humiliated, rejected or embarrassed. This makes them unable to function properly in their social, occupational and other areas of life.

[Read more]

4. Specific Phobias

These refer to an intense, unreasonable and overwhelming fear of creatures, things or situations that pose little to no threat. According to researchers 12, people with specific phobia experience panic attacks along with fear when they are exposed to what they fear, or even when they anticipate being exposed.

[Read more]

5. Agoraphobia

This phobic-anxious syndrome 13 refers to an unreasonable fear of certain places and situations, such as open spaces, crowded places, public transportation, enclosed spaces etc., especially from where potential escape is difficult. This can lead to panic attacks, feelings of entrapment, embarrassment or helplessness.

[Read more]

6. Panic Disorder

This type of anxiety disorder involves unexpected and recurrent panic attacks 14 along with persistent worry and fear even in the absence of any potential threats or danger. Common symptoms 15 include increased heart rate, trembling, shaking, sweating, shortness of breath, chest pain, dizziness, nausea, tingling sensations, depersonalization, derealization, fear of losing control etc.

[Read more]

7. Obsessive compulsive disorder (OCD)

This is a disorder 16 in which a person has constant intrusive thoughts and engages in repetitive actions, also known as compulsions, as a response. Some examples of compulsions are excessive cleaning, continuously counting, frequent hand washing, etc.

[Read more]

8. Selective Mutism

A person with selective mutism is unable to speak 17 in social situations although they may speak normally otherwise. This mainly occurs due to disproportionate expectations to speak. According to a 2010 study 18, it is a rare disorder that typically affects children who are entering school age.

9. Substance/Medication-Induced Anxiety Disorder

Here anxiety occurs primarily as a result of substance (drugs or alcohol) use, withdrawal or during medical treatment. It can cause panic attacks or significant emotional upset.

10. Anxiety Disorder Due to Other Medical Conditions

This includes symptoms which are caused by physiological effects of other medical disorders and illnesses. Here, anxious feelings typically develop directly due to the onset of another medical condition 19.

Signs And Symptoms Of Anxiety

The different forms of anxiety disorders have separate symptoms 20, some of them have been mentioned below.

Symptoms of anxiety
Anxiety
  1. Repetitive, uncontrollable, and intrusive thoughts
  2. Avoidance behaviors
  3. Distress, panic, and fear
  4. Rapid breathing or shortness of breath
  5. Anticipation of impending dangers or doom
  6. Increased heart rate
  7. Increased irritability
  8. Trouble sleeping
  9. Restlessness or inability to remain calm
  10. Difficulty concentrating
  11. Hot or cold flashes
  12. Tingling sensations or numbness
  13. Nausea & dizziness
  14. Unexplained pains & aches
  15. Tense muscles
  16. Sweating
  17. Fatigue or exhaustion
  18. Dry mouth
  19. Gastrointestinal (GI) problems

It should be noted that the symptoms can get worse due to the consumption of specific medications, caffeine, alcohol, and other substances.

Causes Of Anxiety

The exact causes for the development of anxiety disorders are not clearly understood. Experts believe that the condition may develop due to a combination of different factors. Some of the most common factors that may influence the onset include the following –

1. Genetics

Genetics play a major role in the etiology of this disorder. Research 21 shows that the heritability of these disorders is around 30%-67%. Hence, you are more likely to develop this condition if you have a first-degree family member with an anxiety disorder.

2. Environmental factors

Researchers 22 have observed that factors, such as family dynamics, religion, culture and adverse childhood experiences, like abuse and maltreatment, can affect our likelihood of experiencing anxiety. Both childhood trauma and chronic pain are considered to be risk factors for developing anxiety.

3. Brain chemistry

Changes in brain structure can also be an influencing factor – as issues with electrical signals in our brain can influence how we experience fear and other emotions. Studies 23 show that anxiety disorders are marked by a range of neuroanatomical, neurotransmitter and neuroendocrine disruptions.

4. Medical conditions

Other health conditions 19, side effects of medications, chronic pain or injuries or intensive surgery can cause anxiety. Some common medical causes for the onset of this disorder may include –

  • Side effects, withdrawal or misuse of medications
  • Diabetes
  • Respiratory disorders like asthma
  • Irritable bowel syndrome
  • Heart disease
  • Chronic pain
  • Heart disease
  • Thyroid problems
  • Tumors

5. Substance use

Abuse or withdrawal from recreational or illicit drugs can also lead to anxious feelings in the long run. Although certain drugs can be used to reduce stress and anxiety, alcohol and substance use 24 like cocaine can often lead to an anxiety disorder.

Some other anxiety risk factors may include –

  • Personality traits, like shyness and withdrawal
  • Gender 25
  • Sexuality 26
  • Race 27
  • Illness
  • Family history of mental illness
  • Childhood abuse
  • Trauma
  • Stressful life-events, like death of a loved one, etc.
  • Low self-esteem

Read More About Self-esteem Here

Diagnosis Of Anxiety Disorder

In order to diagnose the condition, a healthcare professional or a doctor may ask the patient about their symptoms, medical history, and family history.

Although there are no specific medical tests to diagnose anxiety, a doctor or a mental health professional may recommend certain physical examinations and lab tests, like urine or blood or tests to rule out any underlying medical conditions that cause the symptoms.

Psychologists/psychiatrists usually conduct a mental status examination 28 and use certain psychometric assessments 29 and scales in order to come to a diagnosis of a certain kind of anxiety.

Once the anxiety diagnosis is done properly, the doctor will devise an effective treatment plan that is focused on the recovery needs of the patient and family members.

Treatment Of Anxiety

If the symptoms of anxiety are affecting and impairing the patient’s ability to perform daily functions, then seeking medical help is essential. According to a 2018 study 30, both psychotherapy and pharmacotherapy are considered effective. However, developing the treatment plan may depend on certain factors such as –

  • Severity of symptoms
  • Needs & preferences of the patient
  • Durability and latency of the treatment
  • Anticipated side effects
  • Availability of the treatment

Treatment must also focus on any underlying condition, if present. Here are some of the most common and effective treatment options available for anxiety disorders –

1. Pharmacotherapy

Different types of medications may be prescribed by a doctor to treat anxiety and associated disorders. As per research 2, common medications typically include –

  • Selective serotonin reuptake inhibitors (SSRIs)
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs)
  • Beta-blockers
  • Mild tranquilizers
  • Sedatives.

These medications help to balance chemicals in the brain and relieve the symptoms. SSRIs, and possibly SNRIs, are the first-line treatments for most anxiety disorders, explains a 2012 study 31.

2. Psychotherapy

Psychotherapy 32, and counseling can enable the patient to better understand and regulate their own thoughts, emotions and behaviors. A therapist or a mental health professional, like a psychiatrist or a psychologist, can help the patient to understand the underlying causes of their fears and anxieties, gain new perspectives to approach triggers differently and develop helpful coping strategies.

Studies 33 have shown that psychotherapy is highly effective in treating anxiety and mood disorders. Cognitive behavioral therapy (CBT 34), a form of psychotherapy that is known to be an effective treatment 35 approach for anxiety disorders. CBT is a short-term treatment focused on skills that helps to change maladaptive emotional responses by improving your thoughts & behaviors.

Natural Remedies for Anxiety

Apart from therapy and medication, experts recommend a few natural methods 36 to deal with anxiety, such as:

  • Aromatherapy with essential oils like lavender, lemongrass etc.
  • Herbal tea rich in antioxidants
  • Grounding exercises, like deep breathing, holding a piece of ice, etc.
  • Taking a short walk or exercising
  • Mindfulness meditation
  • Melatonin supplements
  • Consuming food with omega 3 fatty acids
  • Journaling
  • Pet therapy
  • Healthy and balanced diet, etc.

How To Deal With Anxiety?

Apart from medical treatment and therapy, certain self-help techniques can also help you cope with anxiety. Below are some of the coping strategies:

How to cope with anxiety.
Anxiety

1. Educating yourself about anxiety disorders

Learning about your condition will help you identify triggers and take steps before symptoms worsen.

2. Learning to relax

Certain relaxation techniques 37, such as deep breathing, meditation, yoga and massage can help one soothe physical and emotional symptoms.

3. Developing stress management skills

Managing stress can help to overcome triggers and make challenges seem more manageable and less terrifying.

4. Engaging in physical exercise daily

Regular exercise 38 and physical activity can help to improve the symptoms by releasing brain chemicals and promoting positive emotions.

5. Building a support network with your loved ones

Talk openly with friends and family members you trust. You can also join a local or online support group.

6. Following the treatment plan

Strictly follow the instructions given by your doctor, take medicines as prescribed, attend therapy sessions regularly and inform your doctor about any concerns that you may have.

7. Avoiding substances and alcohol

Stay away from illicit, recreational drugs and alcohol 39. It is also important to avoid caffeine and nicotine as well.

8. Socializing

Attend social events and spend more time with your friends. Focus on developing healthy connections instead of withdrawing or isolating yourself.

9. Making healthy lifestyle changes

Certain lifestyle changes can be beneficial in coping with anxiety, such as –

  • Practice good sleep hygiene and get enough sleep
  • Eat a healthy and nutritious diet
  • Keep a journal & write your thoughts
  • Develop a positive mindset
  • Consult your doctor before taking over-the-counter (OTC) drugs or alternate remedies

Takeaway

Although anxiety is a normal emotion, anxiety disorders are mental health conditions that require treatment and support. Moreover, a healthy lifestyle and diet can also prove to be beneficial in reducing the symptoms and living a healthier life. However, if left untreated it can severely affect your ability to function in daily life. So if you are experiencing anxiety, make sure to consult a doctor or a mental health professional immediately.

At A Glance

  1. Anxiety is our natural reaction to stress and is typically considered a healthy response that alerts us to perceived threats.
  2. Persistent anxiety can, however, become eventually dangerous.
  3. The main symptom of anxiety disorders is excessive fear or worry.
  4. The causes of anxiety have been attributed to genetics, environmental factors, substance use, etc.
  5. Although anxiety is a normal emotion, anxiety disorders are mental health conditions that require medical attention.
  6. Anxiety disorders can be successfully managed with psychotherapy and medications.

Frequently Asked Questions (FAQs)

1. How long can anxiety chills last?

During a panic attack, one can experience chills which can sometimes last for 15-20 minutes.

2. What is the most commonly diagnosed anxiety disorder?

As per recent data, specific phobia is the most prevalent anxiety disorder. 40 GAD, panic disorders, agoraphobia and OCD are also quite commonly diagnosed.

3. Can anxiety lead to suicide?

Compared to other disorders, anxiety disorders are a weaker predictor of suicide.41 However, certain anxiety disorders such as panic disorder and post-traumatic stress disorder are independently associated with suicide. 42

4. How do you relax with chronic anxiety?

Medication often helps people with chronic anxiety function better. A combination of medicines and therapy is considered quite effective.

5. What is the difference between performance anxiety and anxiety disorders?

Anxiety disorders encompass a wide range of different disorders. Performance anxiety is a type of social anxiety disorder, wherein one experiences intense fear of having to speak or perform in public.

6. How does anxiety affect the body?

Anxiety symptoms are connected to the amygdala and limbic systems in the brain. Some of the bodily symptoms of anxiety include palpitations, diarrhea, dry mouth, muscle tension, shortness of breath, etc. 43

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